Diabetes mellitus Diabetic hypoglycaemic emergencies

Immediate assessment

Is the patient known to have diabetes?

Possible symptoms observed by staff or described by patient 

• Sweating Headache 
• Tingling Lips 
• Pallor 
• Hunger 
• Feeling Faint 
• Confusion 
• Palpitations 
• Collapse 

Confirm with BM Stick 

• Meter reading less than 3.5 
• Visual less than 4

Immediate action

Call Dr on call to confirm Hypo and/or exclude other cause 

Treat initially with 

• Lucozade l0gms (1" in glass) OR 
• Dextrose tablets x3
• Milk one glass
• Sweetened drink 2 teaspoons sugar
• Squash (not diet) not too diluted

ONLY IF THE PATIENT CAN SAFELY SWALLOW

REPEAT ORAL TREATMENT IF SYMPTOMS NOT RELIEVED IN 5 MINUTES

Have available 

1. Glucagon injection 1mg 
2. Dextrose for intravenous injection 50mI of 50% or 200m1 10% or 100ml 20%.

Doctor 

Hypoglycaemia confirmed with BM reading/and/or rapid relief of symptoms after oral glucose

IF BM ABOVE 4.0 AND NO RELIEF FROM ORAL TREATMENT

CONSIDER OTHER CAUSE (MAY CHOOSE TO SEND LAB BLOOD SUGAR)

If patient unable to swallow safely 

• Give Glucagon 1mg S/C (under 12 years 0.5 mg) (may cause vomiting) -> 200 ml 10% IV dextrose - or equivalent (50% dextrose can be very difficult to give and painful locally)

Other action

When symptoms relieved and patient can swallow- follow up with longer lasting CHO. i.e. 2 biscuits. sandwich, meal.

What next

• Consider cause 
  ?missed meal; ?needs treatment adjusted 
  (CHANGE TO SHORT ACTING OHA IN ELDERLY) 
• Consider admission if confused despite normalised blood glucose.
• Education of patient prior to discharge

Source: Northumbria NHS Health Care Trust diabetes protocol

• Brad Cheek: last updated Dec 2006
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